超声造影和弹性成像鉴别良恶性甲状腺结节作用的Logistic回归分析

目的 应用Logistic回归模型评价超声造影及弹性成像在甲状腺结节良恶性鉴别诊断中的价值.方法 对149例患者的甲状腺结节进行超声造影及弹性成像检查,建立以甲状腺结节超声特征为变量的Logistic回归模型.绘制受试者工作特征曲线,评价Logistic回归模型的预报能力,通过比较各变量的似然比,评价超声造影及弹性成像在甲状腺结节良恶性鉴别诊断中的价值.结果 运用前进法二分类Logistic回归分析,筛选出对甲状腺结节良恶性鉴别诊断中有统计学意义的特征变量包括钙化、增强程度、最大灌注强度及弹性评分.超声造影定量指标的似然比明显高于其他变量.所建立的回归模型对甲状腺结节良恶性预报的正确率为91.90％.结论 超声造影和弹性成像对诊断甲状腺结节的良恶性具有较高的价值,所建立的Logistic回归模型具有较高的诊断正确率.     

Infratemporal gout tophus--a rare differential diagnosis in primary parotid gland disease

Soft-tissue tophi can be observed in up to 50% of patients with primary gout. They are firm deposits of monosodium urate in crystal form, which develop from pinhead-size to egg-size in the subcutaneous tissue. In the field of ear, nose, and throat diseases tophi have been described in such rare locations as the wing of the nose, the tongue, the epiglottis, and the arytenoid and thyroid cartilage. Tophus formation at the temporomandibular joint with extension into the fossa infratemporalis has been mentioned only three times in the world literature. -In the present paper, the authors report on the extraordinary location of an urate tophus in the fossa infratemporalis - in this case, there was even destruction of the middle base of the skull - which had been misinterpreted for years, having been diagnosed as a primary disease of the parotid gland.     

Examination technique in ultrasound calculus detection in the submandibular gland]

Techniques such as orthopantomography and ultrasound are usually employed for examination for submandibular calculi, but we have found transverse scanning of the submandibular gland by ultrasound to be safe and rapid. As the mandible and hyoid bone present a shadow there is a margin for possible error, but this technique enables these areas to be seen and thus checked: a submandibular calculus may be seen as a third shadow between the other two. Comparison showed ultrasound to be superior to orthopantomography. If the ultrasound is negative and there is a strong clinical suspicion of a submandibular calculus orthopantomography is the next step to be employed.     

Pediatric Kikuchi-Fujimoto disease masquerading as a submandibular gland tumor

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a rare disorder that typically affects the cervical lymph nodes. The disease usually occurs in women in their late 20s or early 30s. Reports in the pediatric literature are sparse. Most authors consider Kikuchi-Fujimoto disease as a self-limiting disorder that requires no specific management but long-term follow-up. The clinical features of Kikuchi-Fujimoto disease are easily confused with other less-benign conditions. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigations. We describe a case of Kikuchi-Fujimoto disease in an 8-year-old boy which presenting as a submandibular gland tumor. The case illustrates the clinical features of this unusual condition and emphasizes the potential confusion with other diagnoses.     

Effect of initial treatment on disease outcome for patients with submandibular gland carcinoma

OBJECTIVE: To elucidate the effect on outcome of initial surgical enucleation with or without definitive surgical resection and radiation therapy for patients with submandibular gland carcinoma. DESIGN: Retrospective clinicopathological review. SETTING: Tertiary referral center. PATIENTS: Eighty-seven consecutive patients (mean follow-up, 8.7 years) with primary submandibular gland carcinoma. MAIN OUTCOME MEASURES: Review of proven cases of primary carcinomas of the submandibular gland treated at our institution during a 33-year period to determine the effect of the type of biopsy and subsequent treatment on locoregional disease control, disease-specific survival, and overall survival. RESULTS: There was no statistically significant difference in locoregional disease control, disease-specific survival, or overall survival between patients undergoing enucleation of the gland vs patients undergoing enucleation of the gland followed by definitive surgical resection before any radiation therapy. There were no locoregional recurrences among 28 patients treated with enucleation and radiation therapy, compared with 3 locoregional recurrences (7%) among 42 patients treated with enucleation followed by definitive surgical resection before any radiation therapy. Twenty-nine (69%) of 42 patients undergoing a second surgical procedure had evidence of residual carcinoma in the final surgical specimen. CONCLUSIONS: En bloc surgical resection followed by radiation therapy remains the standard treatment for patients with submandibular gland carcinoma. Patients without clinical and radiographic evidence of disease after enucleation may be adequately treated with subsequent radiation therapy. Definitive surgical resection remains the treatment of choice for patients with clinical or radiographic evidence of disease after enucleation of the gland.     

Prophylactic neck dissection for submandibular gland cancer

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in T1, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma, 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomyohoid neck dissection is suitable for N0 cases of submandibular gland cancer because of four reasons: 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in N0 cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.     

Tumors of the submandibular gland

Primary neoplasms of the submandibular gland do not hold a statistically impressive position when compared to other tumors in the head and neck. Due in part to their relative rarity, incorrect preoperative diagnosis is not uncommon, but perhaps of more significance is the lack of an adequately prepared management program of these lesions. This presentation reviews tumors of the submandibular gland at the Charity Hospital in New Orleans, La., for the 24-year period 1948-1971.     

Treatment outcomes of sialendoscopy for submandibular gland sialolithiasis

ObjectiveSialendoscopy is a procedure used to remove salivary stones intraorally using a sialendoscope. In this study, we identified treatment outcomes of sialendoscopic surgery and identified predictive factors for successful stone removal by sialendoscopy alone.MethodsWe assembled the medical records of 144 patients who underwent sialendoscopic surgery for submandibular gland sialolithiasis at the Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, from October 2010 to November 2021, and collected patient backgrounds, medical condition, perioperative factors including operation method and complications, postoperative course, and stone constituents from a clinical laboratory testing company.ResultsSubmandibular gland stones were successfully removed using sialendoscopy in 58 patients (40%). In multivariate analysis, location, major axis, and mobility of the stones were independent factors for successful removal. In receiver operating characteristic analysis, <7.5 mm of a major axis may be used as a measuring standard for successful removal. Removal of parenchymal stones is prone to involve prolonged operation times, increased postoperative complications, and development of retained stones. The stones mainly consisted of calcium phosphate and protein, with content percentages ranging from 0 to 98% (median 37%) and from 0 to 100% (median 63%), respectively. The percentage of calcium phosphate was negatively correlated with the number of floating stones and successful stone removal.ConclusionSialendoscopy is an aesthetically attractive treatment for sialolithiasis that avoids cervical incisions. The present results showed not only known but also new predictive factors for the successful removal of stones (<7.5 mm) and percentage of calcium phosphate. Moreover, our results suggest that careful consideration is required regarding the indication of sialendoscopic surgery in patients with parenchymal stones.     

Surgical complications of submandibular gland excision

Introduction and objectivesSubmandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications.Material &; MethodsRetrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010.ResultsA total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology.ConclusionDespite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience.     

Intraductal papilloma of the submandibular gland

Salivary tissue intraductal papillomas are rare, benign tumours that predominantly affect minor salivary glands. We report a case of an intraductal papilloma arising in the unusual site of the submandibular gland. The tumour was completely excised and recurrence is not expected. A brief review of this histologically distinct lesion is presented.     

Plexiform neurofibroma of the submandibular gland

A rare plexiform neurofibroma of the submandibular gland in a patient with neurofibromatosis is presented. The clinical manifestations of the disease are reviewed. The need for early diagnosis of neurofibroma is emphasized because of malignant transformation.     

Unilateral aplasia of the submandibular gland

The congenital absence of major salivary glands is an extremely rare disorder. In this case, we report a 32-year-old woman who came to us with right submandibular gland aplasia, which was detected incidentally. The literature on this rare occurrence is reviewed and the significance of the patient is discussed.     

Parasympathetic schwannoma of the submandibular gland

Schwannomas of the submandibular gland have only been documented sporadically throughout the medical literature. We describe a case of schwannoma of the submandibular gland originating from the submandibular branch of the lingual nerve, which carries the preganglionic parasympathetic nerve fibers. The clinical aspect of this tumor is discussed, followed by a brief literature review.